are now to be reviewed. The majority of these in their immediate causes and mode of cure, intimately anastomose; and the principal differences in the symptoms are to be ascribed to the different organs and parts enraged by inflammation. These are not like the generality of the preceding fevers, in which most of the corporeal functions participate: here, in many cases, one single portion of the human organization is originally transfixed with pain and commotion; and doomed to bear the brunt of the hydraulick torrent and inundation. After mature consideration, we imagined it would occasion less confusion and burthen to the memory, to detach a few diseases from the phlogistick legion. Inflammation of the ears, eyes, intestines, kidneys, and bladder, are incorporated amongst the other diseases by which those various organs are liable to be invested. I am aware that this does not quadrate with the stiff etiquette of nosological parade: but, without digressing into a critical disquisition on this subject, I shall content myself with simply acknowledging that I am no convert to any of those modern pedagogues in morbid arrangement and nomenclature. With similar and intentional omission, I avoid the technical subtilities of parenchymatous and membranaceous inflammation.
Phrenitis vera. As a primary disease, it is very rare in this kingdom. It is much more frequent in tropical and hot climates: and is the febrile calenture of those scorching regions. With us it is mostly symptomatick in different fevers: and may either affect the brain and medullary substance, or its investing membranes: and in the former case the delirium is said to be mild. Morbid dissections have proved, that when inflammation was believed to be present, none could be discovered; and in other cases, that the brain was inflamed, without expressing the usual symptoms. Of idiopathick phrenzy, the symptoms are, fever, excruciating and deep seated headach, restlessness, and want of sleep; intolerance of light and noise, with acute sensibility and irritability; red, prominent, ferocious eyes; audacious, and flushed countenance; contracted and languid pulse; throbbing of the temporal arteries; noise in the ears; change in the voice; impetuous delirium, and the patient, with difficulty, restrained in bed; dry parched tongue, but sometimes no complaint of thirst; costiveness; limpid urine. It is extremely dangerous and precipitate, terminating in a few days in recovery, death, or some other disease; and is rarely protracted beyond a week. The favourable crisis is various: by nasal hemorrhage, sweats, diarrhœa, turbid urine: but on any irregularity or intemperance, convalescents are prone to relapse. The predisposing and occasional causes are, warm climate; insolation, especially with the head uncovered; sudden suppression of the puerperal lochia; intoxication; violent passions of mind; ambition, anger, grief, profound contemplation, unremitting study; long deprivation of sleep; external injuries; erysipelas, or scald head prematurely repelled; violent exercise; symptomatick.
cynanche, quinsey; and distinguished into the inflammatory; and into the putrid, gangrenous, or malignant. The mortality by quinsey and sore throat, appears in the London bills inconsiderable; and without discrimination of the inflammatory and putrid. Inflammatory angina is a general and frequent affliction in both sexes, and especially in ours and some northern regions. Adults more than infants; and some individuals more than others, are obnoxious to it: its reign is in spring and autumn, on the change and vicissitudes of the seasons, or of heat and cold. In that very different species, the Gangrenous Angina, the ancient authors are nearly barren of information: some years this is epidemick and contagious in different parts of our island; and is much more inimical to childhood and adolescence than to adults; discharging its venom on schools, and the younger branches of families.
The principal differences in inflammatory angina are in the parts affected, and the degrees of inflammation; which may be in one or in both sides; and variously extended over the mucous membrane of the fauces, tonsils, velum, uvula, pharynx, and larynx. The usual symptoms are difficulty and pain in deglutition, and sometimes in respiration; internal intumescence and redness of the fauces, stiffness of the neck, and the lower jaw moved with pain; frequent and difficult in excreation of viscid mucus and saliva, and clamminess of the mouth and throat; impediment in the distinct articulation of words and speech; noise and darting pain in the ears; flushed face, prominent eyes; quick, strong, and hard pulse; anxiety, restlessness; sometimes considerable contiguous tumor externally; and in violent inflammation, necessity of an erect posture of the head, to prevent suffocation: the more the pharynx is affected, deglutition is proportionally interrupted; and some cannot swallow food or liquids during several days. The crisis is in a few days, at the utmost in a week or two, by resolution, or by suppuration; seldom or ever by gangrene. Resolution or discussion is accompanied with copious excreation and salivation; and frequently with critical perspiration, sweats, urine. Suppuration may be artificially discharged, or may spontaneously burst internally or externally. With judicious and opportune assistance, there is trifling danger. When fatal, it is by suffocation. The predisposing and occasional causes are cold air inspired cold and moist air: perspiration suddenly checked, especially on the neck; cold water drank when the body is heated: epidemical influence of the air and seasons.
Inflammation principally attached to the muscles of the os hyoides, glottis, larynx, and trachea, is fortunately far less frequent than the former. In this, the current of air being intercepted, there is necessarily difficulty and pain in respiration, quick short breathing, sense of strangulation, great anxiety and restlessness; acute squeaking or ringing sound of the voice; quick and irregular pulse. Of that disease, which at least in symptoms has considerable analogy with the present, and called with us the Croup, we are hereafter to treat. We may here, however, with propriety, subjoin two other inflammations, the Angina Parotidea, and the Glossitis. The Angina Parotidea is often epidemick, but not dangerous. It commences as a glandular tumor externally, at the articulation of the lower jaw, becoming gradually more enlarged and unequally diffused, increasing to the fourth day, and from thence declining: and often is succeeded by swelling of the male testicles, or of the female breasts. The Glossitis is rarely a primary disease; but mostly complicated with angina, or venereal salivation. Its symptoms are obvious; pain and swelling of the tongue; speech and deglutition exercised with difficulty, headach, restlessness, flow of saliva. If violent in the extreme, there is danger of suffocation or starving.
The strong cardinal outlines in the features of Angina Gangrenosa are, symptoms of nervous and putrid fever, with ulcerations in the tonsils. Upon these we shall enlarge in their rotine and detail: soreness or uneasiness in the fauces and throat; stiffness of the neck; headach, nausea, and vomiting; the fauces and tonsils inflamed, but seldom in any considerable degree, of a shining crimson colour, with ash-coloured spots on the tonsils, and sloughs, forming soon into corroding ulcers; some pain is felt in deglutition; there is sudden prostration of strength; depression of spirits; anxiety and oppression at the breast; small, quick, and fluttering pulse; dizziness in the head; slight delirium, especially at the nocturnal exacerbation; heavy, red, and watery eyes; the tongue foul at the root; in some the voice hoarse; and in most the nostrils excoriated by a sharp defluxion; the breath unusually fetid, and generally the fecal discharge: the external tumor of the fauces, when visible, which, so far as my experience reaches, was rarely the case, is edematous, indenting by pressure. In most cases there is a cutaneous efflorescence overspreading the face, neck, and other parts of the body, in small points, scarcely eminent, or in confused and confluent blotches: the period of this eruption and of its duration varies; and with its recedence there is desquamation of the cuticle.
This is infinitely more dangerous than the inflammatory angina, terminating salutary or fatal from the third to the seventh day, according to the degrees of virulence and medical aid. Alarming symptoms are, great debility; cutaneous petechiæ; the internal functions of the brain much deranged; weak, quick, fluttering, and irregular pulse; livid colour of the ulcers; refusal of drink and medicine; together with the other inauspicious symptoms enumerated under febrile prognosticks in general. I have seen not only petechiæ, but also putrescent hemorrhages from the nose and gums in this disease. At the crisis there are often fetid stools; but whether critical, or from the acrid matter swallowed, may be disputed. General sweats and excreation of the ulcerous sloughs are favourable omens. By the speedy and judicious assistance of remedies and regimen, very few, compared to the sick and infected, sink. It is epidemick and contagious: but of the source or nature of the contagion, we are unacquainted.
is a frequent inflammation in northern climates; and most so in spring, autumn, and winter; when the body, hydraulick canals, and blood are in a state of inflammatory diathesis: it generally encounters the robust vigorous constitution, those of strong muscular fibre, and dense rich blood; the athletick rustick, manufacturer, and artizan; those in the prime, and in all the intervals between twenty and the decline of life: it is very rare in infancy, as in idiopathick disease, and seldom under puberty, or in old age. It is most universal amongst the male sex; and in all probability, both more universal and destructive amongst the necessitous laborious mass of the community. We also read in authors, of spring pleurisies as no unusual affliction in some climates considerably nearer to the equator than ours. I apprehend, that in the London registers the mortality by pulmonick inflammation is under-rated, and perhaps delegated to imposthume and consumption.
Nosologists have enumerated several extraneous symptoms as complicated species of pleurisy and peripneumony; such as bilious, erysipelatous, catarrhal, rheumatick, intercostal, arthritick, verminous, flatulent, scorbutick, putrid, and malignant: most of which are merely symptomatick: for neither rheumatick pains in the intercostal muscles, nor flatulence pent up in the intestines, can impose on medical discernment as genuine pleurisy. The primary seat of pulmonick inflammation, whether in the parenchyma or internal viscus, or in its investing membranes, is not clearly established in medical diagnosticks; and therefore we comprehend pleurisy and peripneumony under one genus: in most cases they are complicated; and it is now doubted whether any pure peripneumony occurs without the pleura also participating in the affliction. The inflammation confined to the pleura alone, was described as unaccompanied with expectoration; hence the distinction of dry and humid species; and in genuine pleurisy the pain was represented as more acute than in peripneumony.
The symptoms of pulmonick inflammation are fever, darting pungent pain fixed like a dagger in some part of the chest, the side, breast, or back; and sometimes shooting to the scapula and clavicle: sometimes the pain is more dull and obtuse; and its situation oftenest in the side, about the middle of the ribs, between the sternum and spine; and commonly confined to one lobe. At the invasion there is shivering, restlessness, anxiety, succeeded by heat: hot accelerated laborious respiration; load and oppression at the breast; urgent, short, and painful cough; and very early in the disease more or less expectoration, streaked with blood; the pain is exasperated by inspiration and coughing, and mostly fixed, but sometimes veering or shifting: the pulse quick, full, hard, and tense, like a stretched chord; the blood drawn forms a buffy tenacious crust on the coagulum; the urine is of a florid colour: from the violence of pain, patients are often unable to lay on either side, but compelled to recline half-erect on their backs: when the inflammation is violent, or both pulmonick lobes assailed, there is inexpressible anxiety and struggle in respiration, florid countenance, prominent eyes; with other symptoms of obstructed circulation, and return of blood from the head, and menacing suffocation. In the advanced or dangerous stage of the disease, the pulse is weak, soft, and irregular. Sometimes there is nausea of the stomach; and sometimes delirium.
The termination of pulmonick inflammation is by resolution, by suppuration, by gangrene, by fatal effusion of blood, or exudation of coagulable lymph into the cellular texture. Favourable symptoms are, as in anginous excreation, facility in expectoration, without much exertion or coughing, copious, of due consistence, a little yellow, white, thick, slightly streaked with blood; the sooner this is concocted and excreted, the sooner is the crisis; less urgent and painful cough; freer breathing; abatement in the heat of the body and velocity of the pulse; general perspiration; deposition of sediment in the urine; nasal hemorrhage; dispersion of the pain, hitherto fixed in the thorax, about the shoulders, back, or arms; erysipelas in some external part; pustular eruption about the breast, neck, and scapulæ; abscesses in different parts. A crisis, when favourable, always ensues within seven, or at the utmost fourteen days; and after such crisis, expectoration may continue copious several days.
Inauspicious symptoms are, the respiration struggling and laborious in the extreme; dry pertinacious cough; no expectoration, or with difficulty; suppressed expectoration; obtuse pain, with difficult respiration; frequent violent cough exasperating the pain; the pain changing from one side into the other; the pulmonick lobes in both sides inflamed; the breathing intolerable and suffocating, except in an erect posture, and even then with laborious anxiety; the face turgid and florid, or pale, with features of consternation; violent headach; delirium; remission succeeded by relapse; excessive sweats; dry skin; weak, soft, and irregular pulse; sudden cessation of pain; grumous livid expectoration; rattling noise in the thorax, as if plugged up by phlegm; dejected countenance, squalid sunk eyes; great prostration of strength; cold clammy partial sweats; limpid urine; florid blood coughed up, or white and glutinous matter resembling the branches of blood-vessels. Effusion of blood, and exudation of coagulable lymph into the pulmonary cellular texture, bronchial vesicles and air-pipes, is more frequently than gangrene, the cause of suffocation and death. The occurrence of either is seldom later than fourteen days. There is also great danger of pulmonick inflammation, persevering beyond seven or, at the utmost, fourteen days, and without any considerable remission or signs of resolution, terminating in suppuration; of which the diagnosticks are hereafter marked. Authors have likewise described a malignant peripneumony, which seems to be a complication of the preceding deleterious symptoms, and of putrid fever.
There is, however, a species of pulmonick affliction, the specifick diagnosticks of which it would be unpardonable to omit; because it has often and fatally been either confounded with, and treated as genuine pulmonick inflammation, or slighted as a catarrh. This is named Peripneumonia Notha; whose symptoms, at the onset, are ambiguous. It is most frequent in persons old, phlegmatick, fat, weak, emaciated, subject to catarrh, addicted to fermented and spirituous liquors; and in foggy weather and rainy winters. It appears in the same seasons with genuine pulmonick inflammation, and with catarrh; that is, in spring and autumn; and frequently under the veil of a violent catarrh. The fever and heat are inconsiderable; the pulse not hard nor tense; but there is straitness and difficulty of breathing, and load at the breast, with anxiety and gasping for breath; urgent violent cough, with some expectoration, and sometimes exciting vomiting; giddiness of the head; rending headach; sometimes drowsiness. It is sometimes suddenly and unexpectedly aggravated, and suffocates the patient.
The predisposing and occasional causes of pulmonick inflammation are, epidemick state of the air; sudden vicissitudes of the seasons and weather from heat to cold; sudden suppression of perspiration, or of pulmonary exhalation; inspiration of cold air; sudden exposure to keen cold air, especially after breathing in a warm room, or drinking warm liquors; cold liquors drank when the body is heated; intemperance and sottishness, particularly in spirituous liquors; dry cold winds; strong muscular exercise, or manual labour; repulsion of cutaneous eruption, febrile or chronic; exsiccation of old ulcers; suppression of habitual evacuation and eruption; translation to and deposition of morbid matter on the lungs; consequence and dregs of small pox and measles; symptomatick from some other diseases.
Inflammations of the heart, mediastinum, and diaphragm, as solitary, are very rare diseases. The symptoms of Carditis are severe fever; pain and anxiety in the region of the heart; difficulty of breathing; cough; irregular pulse; palpitation, syncope. Inflammation of the diaphragm, paraphrenitis: the symptoms are, acute fever, intense pain in the breast darting to the back, and increased by inspiration, coughing and sneezing, and by natural exertion at stool and urine; restlessness, anxiety, dry cough, quick convulsive breathing; sneezing, hiccup, nausea, vomiting; compulsive painful grin on the countenance, delirium. When it occurs, it is generally complicated with inflammation of the adjacent organs, in either the thorax or the abdomen. As the heart is the main spring of the blood’s circulation, and the diaphragm the principal agent in respiration, it is evident that inflammation in either must be extremely dangerous.
hepatitis, acute and chronic. Both species are much more frequent in tropical climates and warm regions, than in northern and cold; and more so in the former during the hottest seasons of the year. The sensibility of the liver being dull, its inflammation is less painful than that of any other viscus. The symptoms are, fever, pain in the right side under the false ribs, and felt at the corresponding clavicle, scapula, and hand; sensation of heat and heaviness in the hepatick region; difficulty of breathing, more especially when the inflammation invests the superior convex part of the liver; there is often dry cough; nausea, bilious vomiting, and diarrhœa; the urine of a fiery or saffron-colour; and generally, but not always, the eyes, countenance, and skin more or less of a jaundice tinge; the pulse not remarkably disturbed; but thirst. Sometimes hepatick inflammation is entangled with that of some contiguous organs of the lungs or abdomen, and with their respective features. The acute hepatitis, but not the chronic, is usually terminated in a few days, at the utmost fourteen or twenty-one, by discussion, suppuration, or gangrene. Critical resolution may be variously accompanied with bilious diarrhœa and urine, nasal or hemorrhoidal hemorrhage, copious bilious sweats. Suppuration is not an unfrequent termination: after which many survive, but with difficult and slow recovery. The purulency may be expurgated by absorption, by the biliary ducts, by erosion of the abdominal muscles, or by an artificial opening when the abscess is perceptible externally; and sometimes it erodes the diaphragm and lungs.
The predisposing and occasional causes are, burning climates; acrid viscid bile; the blood tenacious and glutinous in consistence; calculi, steatome, worms in the biliary ducts; bilious vomiting; sudden refrigeration of the body when heated, and obstructed perspiration; thirst, and not sufficient dilution of the blood; intoxication and abuse of spirituous liquors; poisons; external injuries; violent exercise; passions of mind; inveterate hypochondriasm; translation of purulent matter to the liver; symptomatick.
Inflammation of the Spleen is a rare occurrence: schirrus of that organ is far more frequent. The Peritonitis is also an uncommon inflammatory vagrant: it will be revived hereafter under Puerperal Fever.
gastritis. Notwithstanding the incessant irritation and distinction of this sensible organ, by innumerable varieties of food and drink, yet its inflammation is a rare event. The symptoms, acute fever; fixed burning pain and heat in the region of the stomach, aggravated by pressure; frequent nausea and vomiting after taking any nourishment; anxiety, restlessness; weak, hard, intermittent pulse; frequently delirium; universal debility. It may prove fatal in the space of a few days, or even of a few hours: there are different gradations of severity and danger. The termination is by resolution, suppuration, gangrene. The predisposing and occasional causes are, all the causes of topical inflammations in general; poisons swallowed; cold water, ices, and fruits swallowed when the body is much heated; repletion from food and gormandizing; crude and difficultly digested nutriment; violent agitation of body or mind; external injuries: from repelled gout very rarely.
The three succeeding genera of the phlogistick tribe, so far as respects mere inflammation only, affect the external parts and circumference of the body, and do not suppurate. In other respects there is a distinct tripartite separation, both as to general outlines and minuter shades.
ignis sanct. antonii: gutta rosacea, zoster, zona, herpes. Some trifling pillage by this disease is noticed in the London bills. To adults it is most hostile. The symptoms are, more or less fever; superficial inflammation of some portion of the skin and cuticular membrane, with pain, tumefaction, burning heat, redness, and pruriency, like that from nettles; and variously, in different persons, assailing the face, the neck, the trunk, or one of the extremities: the eruption seldom appears until after the commencement of the febrile commotion; and often from a small point spreads gradually: it never rises to any conical eminence, nor suppurates, but often excites vesications; and if on the face and violent, blocks up the eyelids: the pulse is frequently full and hard; and with the eruptive expulsion the fever and heat do not cease. It is sometimes critical and salutary: the favourable crisis is usually in a few days, or within nine, by perspiration, urine, and desquamation of the inflamed cuticle; and sometimes without any perceptible revulsion to the excretories. Some have this cutaneous inflammation annually, or oftener, or at wider intervals; and those once affected, are more obnoxious to its returns. Presages of danger are, violent inflammation and intumescence on the face, or sometimes even on the legs, particularly in old age, or unsound constitutions; premature retrocession of the eruption; pale colour; frequent return, and repetition of the inflammation; delirium; coma; gangrene. On the legs it sometimes leaves behind a chronic enlargement. The zoster and zona is a species of erysipelatous inflammation, a hand’s breadth or more, affecting the breast, sides, or abdomen, and various in length.
The predisposing and occasional causes of Erysipelas are, epidemick influence of the air; obstructed perspiration; sudden refrigeration of the body when heated; plethora; suppressed evacuations, natural or artificial; luxurious living and indolence; intemperance; spirituous liquors in excess; poisons; unsound constitutions; contusions, wounds, burns, punctured nerves, blisters, acrids; dregs of fevers; scorbutick; lunar influence; passions of mind.
From the Chart of diseases we may rank rheumatism as an inferior piratical foe amongst the morbid host; or rather as a scourge and instrument of torture than of execution. In the acute or chronic form, multitudes are molested by it, especially in this island, and in northern regions: and more so in winter, in spring, and autumn, and the interchanges of the seasons: it seldom molests very young or aged persons: adults are most annoyed by it; the male more than the female sex; the poor and indigent more than the affluent; and those most who are exposed to the inclemency and vicissitudes of the seasons and weather: hence, during war, soldiers and sailors are much more afflicted with it than in peace.
In the acute rheumatism, fever may commence before or after the pain, which variously and alternately seems to dilacerate different parts, especially about the joints of the ancles, knees, hips, shoulders, elbows, and wrists, sometimes the trunk; but rarely the small joints of the toes or fingers: and commonly succeeded by swelling and redness of the distracted joints, and with restlessness: at night the pains are exasperated, and often suddenly abating in one joint, seize upon another; thus harassing the body with a war of posts. In its diagnostic train also are, hard quick pulse, sizy blood, inflammatory urine; sweats sometimes copious, but not critical. Its continuance may be one, two, or three weeks; by which time the fever, if not mismanaged, abates with the pains: it very rarely terminates in suppuration, and in this instance resembles erysipelas and gout. The crisis of the acute is generally by sweats, cuticular efflorescence, nasal hemorrhage. It may terminate inauspiciously in chronic pains, or in consumption: indeed, emaciation is always a consequence.
Chronic rheumatism may occupy all the stations of the acute: in the hips it is called ischias, morbus coxendicis, and sciatica: in the loins, lumbago. In this there is no fever, redness, nor swelling, only pain and often inability to move the affected joints; and this aggravated by change of weather and cold. In the lumbago there is direful pain about the loins, with difficulty in erecting the trunk; but not, as in the nephritis, accompanied with nausea or vomiting, nor pain of the ureters, testicles, or thighs. In the ischias there is severe fixed pain about the hips, os sacrum, and pubis, and often extending down the thigh and leg along the fascia aponeurotica; with difficulty or incapacity of moving the thigh; and sometimes atrophy of that extremity, or sciatic tabes. Chronic rheumatism may harass months, years, with various degrees of severity and exacerbation, and interludes of ease; and is often extremely obstinate and difficult to be dislodged. In many instances also, we observe a contrariety and dilemma whether to affix the name of chronic rheumatism or gout to such pains. In general, rheumatic aches are not so periodical in their returns; and in several other features the two diseases divaricate.
The predisposing and occasional causes of acute and chronic rheumatism, idiopathic and symptomatick, are, sudden suppression of perspiration; sudden heats and colds; cold damp night air, beds, houses, habitations, want of sufficient warm cloathing and fuel in rigorous seasons, or during the interchanges of the seasons; wet cloaths; exposure to heats and colds; sudden vicissitudes of heat and cold; change of winds and weather; one part of the body exposed to cold whilst the other part is heated; sleeping on damp ground; plethora; impure blood; repelled eruption; suppressed evacuations; habitual intoxication; intermittent; dregs of fever; arthritic; hereditary; scorbutick; hysterical; venereal; noxious exhalation from lead or mercury; excess of venery; tabes dorsalis; aneurism of the descending aorta near the loins; lifting great weights; internal abscess and scirrhus; abscess, and caries at the upper articulation of the thigh-bone; sprains; luxation and fracture of its neck; diseases of the coverings of the nerves, or of their medullary substance, or of the muscular fibre.
arthritis, podagra; acute, chronic, regular, and irregular. Here we have no foundation to accuse the elements, or the invisible demons of disease: this malady either immediately, or by hereditary descent, is too often the natural castigation and penance of voluptuousness and sensuality. In the preceding century it was confounded with sciatica in the London bills. During the present century, there is a considerable increase in arthritic mortality; but, compared to some other of the morbid host, it is a mere buccanier. Arthritic piracy must solely be imputed to the assaults of chronic gout, either gradually breaking down the fabrick, or storming some of the internal organs essential to life. It attacks principally the male sex; sometimes, but rarely, females; and of the latter those of robust full habits, the viragines, luxurious, indolent, corpulent, and generally after the final menstrual cessation: the majority, from the peculiarity in the female constitution, and from superiority in temperance, are exempt. It seldom attacks before middle age; generally in the decline of life: the few exceptions of its earlier occurrence are rare; and in them it is usually by co-operation of hereditary, and of remote exciting causes: in adolescence, and before puberty, it would be numbered amongst the medical miracles. It harasses most those of robust, full, corpulent, large frame and temperament, the voracious, gormandizing, affluent, and pampered; more of the patrician than the plebeian orders; more of the literary and sedentary professions; and, according to Sydenham, those of an acute genius and intellectual eminence. The active and industrious orders of every community; those who are exercised in daily corporeal labour, or who, from necessity, design, custom, or religion, do not indulge to excess in animal food, or in wine and fermented liquors, are seldom arthritick martyrs. Compared to the number afflicted, very few die of gout; it has even been by some considered as an omen of longevity: many, subject to it, have reached the Mosaick goal. It has been alledged, to render men more secure from other diseases; and in some few instances to expurgate and renovate a disordered constitution. These observations, however, must be restricted to regular gout only, and recurring at distant intervals.
That periodical local pain and inflammation called the regular arthritic paroxism sometimes invades suddenly, without any warning; but in general there are presages of its approach, one or two days, or even weeks; by ceasing of usual moisture on the feet; coldness, numbness in the feet and legs, enlargement of their veins, muscular cramps; general torpor and languor; restlessness; headach; depression of spirits; impaired appetite; flatulence, indigestion, cardialgy; costiveness. But frequently one or two days preceding the paroxism, the appetite is keener than usual. The regular and recent paroxism commonly invades by nocturnal surprize in bed, with pain in one foot, usually the ball of the great toe, accompanied with shivering, heat, and shortly after, conspicuous glossy redness, tension, and spreading tumor. The pain becomes often so intense as to be compared to premeditated dislocation, or to a dog tearing the flesh and ligaments: and such is the exquisite tenderness in the inflamed part and foot, as not to be able to tolerate the slightest touch or even weight of the bed-cloaths. In this way there are more or less diurnal remissions and exacerbations of pain; which, after one, two, three, or four weeks, recedes gradually and insensibly, together with the redness and swelling; leaving the patient who had been chained to a bed or couch, in perfect health; and soon after, the foot in the exercise of its former suppleness and strength. Throughout the paroxism the corporeal agony renders the mind more irritable and irascible: the urine is acrid, hot, turbid, and fabulous; in many, the perspiration is fetid; and with both general and local sweats, and desquamation of the inflamed cuticle, the paroxism finally evaporates. In vigorous constitutions the paroxisms are sooner terminated: indications of which are, sudden tumefaction, throbbing pain, and frightful sleep. In recent gout the pain is more severe than in chronic; the paroxisms shorter, with longer intervals; and vice versa. Pustular eruptions on the foot sometimes carry off the arthritic fuel.
At the beginning, the paroxisms are shorter, and the periods more regular and distant; at intervals of three or four years, or longer: by degrees the intervals are progressively reduced to two, to one; to two paroxisms annually about the equinoxes and solstices, and during the autumn, winter, and spring; at the same time the paroxisms are protracted to two or three months. At length, in the chronic inveterate stages of the disease the patient enjoys a very short respite; some few of the enervated, perhaps only two or three months during the summer: the pains in the extremities are then indeed less violent; but the stomach is more disordered. In recent gout, one foot only is assaulted; by degrees both feet, one after the other: and in the rooted state of the disease it not only torments both feet in succession, but capriciously deserts and re-attacks various parts; the ancle, knee, elbow, wrist; darting often with electrical velocity and shocks through the nerves and muscular fibres: thus, in a circle of torture and litigious warfare, teazing the arthritick victim.
When either the inflammation of the joints has commenced in the usual manner, but without an adequate degree of pain and inflammation, or at least without continuing the usual time, and precipitately recedes, some internal organ is exposed in its retreat and rebound. Or when the arthritick fuel is occluded, and not ejected to the feet, it will, according to the various parts and organs affected, excite corresponding vibrations and symptoms in the natural, vital, and animal functions; as inappetency, indigestion, nausea, vomiting, flatulence, ventricular eructation, colick, diarrhœa, nephritis, and urinary obstructions; difficult respiration, asthma, palpitation, fainting, general debility, low spirits, hypochondriasm, cramps and spasms in the muscles, apoplexy, palsy. In dubious cases from what source to derive such irregular alarms and minatory explosion; if they happen about the usual arthritic periods, and in such temperaments, their origin may be suspected: and it is of the highest moment to know that they are rarely of an inflammatory nature. After the disease has continued many years with frequent reiterated paroxisms the joints do not soon recover, but continue weak and stiff. In many cases, chalky and calculous concretions are formed in the joints of the extremities, and in the kidneys and urinary passages. Racked by those combined tortures, the patient requires the auxiliary aid of stuffed chairs, flannel, and crutches.
The predisposing and occasional causes are hereditary; inactive sedentary life, with luxurious living and gormandizing, especially on animal food; intemperance in wine, spirituous or fermented liquors; early or intemperate libations to Bacchus and Venus; unremitting application to study or business; sedentary life; nocturnal lucubrations; disturbed sleep, cares, misfortunes, vexation, depressing passions; ceasing of usual exercise or labour; sudden transition from an active to a sedentary life; coaches, dissipation, luxury, effeminacy; sudden violent changes in diet; plethora; suppressed evacuations; profuse evacuations; various causes of debility; indigestion from quantity or quality of aliment.
in the lungs, liver, stomach, intestines, kidneys. Pulmonick suppuration, empyema, or vomica, may be predicted from preceding inflammation, without considerable remissions, the neglect of effectual remedies, and no signs of resolution by the efforts of nature or art, and by remission of acute pain; the difficulty of respiration and also cough continuing; with frequent horrors and shivering, heat and hectic, weight and throbbing in the side, laying on the diseased side painful; dyspnœa aggravated by a recumbent posture; disagreeable taste in the tongue; thirst; fetid breath; emaciation. It may burst in all the intervals between fourteen and sixty days, and either relieves or suffocates, or is gradually expectorated: and sometimes, after absorption, may be evacuated by diarrhœa or urine: the purulent contents may also be discharged upon the diaphragm, or between the pleura and intercostal muscles. Sometimes there are several small abscesses; and too frequently the final termination is ulceration and phthisis. Suppuration in the Liver is a frequent consequence of previous inflammation, and is not altogether so fatal as some other internal abscesses. Its symptoms are those in common with internal formation of pus, horror and chilliness, hectic heat, thirst, weight and load in that region, jaundice-colour of the eyes. Sometimes the purulence erodes the external integuments; sometimes the diaphragm, lungs, or stomach; sometimes is discharged by the biliary ducts into the intestines, or absorbed and washed away with the urine. Suppuration in the stomach and intestines is rare. In the kidneys, the general symptoms, with purulent fetid urine: it may also burst externally; or by slow ulceration and hectic, undermine the constitution.
Of Internal Gangrene in the lungs, stomach, intestines, kidneys, liver. Pulmonick gangrene from inflammation, is predicted by sudden cessation of pain, without any benign crisis: expectoration either suppressed, or yellow, green, black, and fetid; hollow noise in the breast during respiration; dejected countenance; red and heavy eyes; foul and black tongue; quick, languid, and intermittent pulse; fetid urine, stools, and sweat; hiccup; cold sweats; universal debility and sinking of the vital powers. From the preceding symptoms, from those enumerated under general febrile prognosticks, and from the functions peculiar to the different diseased organs, internal gangrene in whatsoever part may be comprehended; and a minute detail would be superfluous.
what extensive ruin do they yet spread! In commenting upon these, I shall, in a trifling degree, invert the prescribed order and arrangement. Into this group are concentrated pulmonick hemorrhage, pulmonary phthisis, the various species of hectick, atrophy and tabes, nervous, sciatick, dorsal, and icterick; also asthma, dyspnœa and cough, catarrh, hooping cough, croup. Inflammation of these organs and spurious peripneumony, have already been described. These, therefore, constitute nearly the whole combined pulmonick host, and likewise some of those diseases closely connected with the pneumonick machinery, or with several of its general morbid symptoms.
Behold here one of the great caravans of dead to the stygian ferry; and tottering myriads crowding to the same shambles. View the innumerable multitude of fable mourners and weeping relations attending them in the last melancholy offices of friendship, to that eternal bourn, the grave! Every introspection of general morbid registers, and the unanimous observations of the medical profession, concord in proclaiming the notoriety of the consumptive throng, and their ruinous uncontroulable domination. Notwithstanding the prodigious improvement in the alphabet, subordinate rudiments, and appendages of the medical science, consumption as yet is one of the great oligarchy of morbid and remorseless tyrants. He would be intitled to every terrestrial honour, and to posthumous apotheosis; he would rival and eclipse the most celebrated tyrannicides, and expurgators of monsters, whether demi-gods, heroes, or saints, who could dethrone or controul this stationary monopolizer of human sacrifices, and sheathe his deadly sword.
From one fifth to one sixth of all the mortality in London, is from consumption; which is nearly double to that even of small pox. But consumption is a term too lax and indefinite. Into this gulph, no doubt, are thrown many febrile and slow hectick emaciations, from infancy to old age, in both sexes; and there are few diseases from acute and chronic sources, especially in their fatal termination, without emaciation. Consumptions and dropsies are the final wreck of a great variety of human maladies. In no two other diseases are, what pathologists term Morbi a Morbis, more apparent: and in multitudes of such cases, morbid dissections often detect the effect, and not the original cause. How many of the genuine pulmonary phthisis are consociated with this miscellaneous crowd, is difficult to guess; but, from the concurrent testimony of physicians, and of experience, we may safely affirm a very large proportion. There are few families in this kingdom whom it has not, one time or other, plunged into tears. Physicians on the continent alledge, that phthisis is more prevalent in Britain than in any other kingdom of Europe.
The next inquiry is, in what age, sex, rank of life, season of the year, and whether in city or country is consumption most predominant? It has been, from the earliest chronology, the universal echo and monotony of medical writers, to mark the principal consumptive age between 18 and 35. But, with submission, I would considerably enlarge its limits, including from birth to 5, and from 20 to 60. No age or stage of life is exempted; but we might “a priori,” and from viewing the great and general scale of mortality, assert, that between 5 and 20, a considerable number cannot possibly be swept away in the phthisical torrent. Nor do we mean to invalidate the general aphorism, that in the blossom and full maturity of vigour and comeliness, phthisis is superlatively deleterious. Between the sexes no distinction seems to be made. I conceive, however, that amongst the lower orders universally, and more especially those penned up in the foul atmosphere of cities, that phthisis is more fatal than amongst those who browse in the pure air of the country. In accommodation, cloathing, noxious trades, &c. the indigent have the disadvantage; and during sickness, from the same causes, their recovery is more desperate. With respect to seasons, winter and autumn in our climate is the most pernicious to pulmonick maladies.
hæmoptysis, sputum sanguinis. The lungs spungy pneumatick and hydraulick organs, in themselves passive; but by the contraction of the diaphragm and intercostal muscles enlarging the capacity of the thorax, this ventilator is alternately distended with atmospheric air, and this sonorous fluid again quickly expelled, with either some noxious emanation from the body, or decomposition of its own vital principle. Half the blood of the human body circulates thro’ this organ: its blood-vessels are numerous and large, and rise immediately from the heart; and it is incessantly in motion and agitation. When the body has nearly attained its ultimate extension and altitude, pulmonary hemorrhage is most predominant; more especially in those of narrow thorax, prominent scapulæ, red cheeks, and acute tone of voice. Before the hemorrhage, there are shivering, horror, heat, fever, weight, oppression, pain and heat in the breast, difficulty of breathing, titillation of the fauces, dry cough, exspuition of florid blood in various quantity, and slowly or suddenly, from ounces to many pounds, or even quarts, in a few days; but the latter is rare. It may soon totally cease, or only intermit, and again return at irregular intervals. Relapses are frequent on any irregularity or intemperance; on acceleration of the circulation, or expansion from heat.
This hemorrhage is very seldom in such quantities to prove precipitately fatal, unless mismanaged. From Bleeding, at least in the London registers, there is petty spoliation. Pulmonary hemorrhage is more frequently the consumptive precursor. Malign omens are an eruptive torrent; ulceration in the lungs; fever renewed; pain in the breast; difficulty of breathing; cough, hoarseness; night sweats; peripneumony; visceral obstructions; cachexy; old age; relapses. But pulmonary hemorrhage from temporary obstructions of the menses, or in pregnancy, or periodical, or without load in the thorax, or fever, are much less mischievous.
Not one hundredth part of pulmonary consumptions commence with hemorrhage. Phthisical lineaments are emaciation, diurnal hectic fever, obstinate rebellious cough, difficulty of breathing, and usually some change in the voice. In the beginning, phthisis often resembles a catarrh, or stubborn cold; and in this insidious disguise is too frequently slighted, or neglected: but continuing longer than the usual catarrhal period, without any considerable intermission, and especially if in summer, are sufficient grounds of alarm. In that, from tubercles, there is frequent teazing dry cough, exasperated at night; some difficulty of breathing, and panting on ascending any eminence or stairs, or on exercise; some emaciation and weakness. By degrees, there is more or less expectoration of viscid, yellow, greenish purulence, intermixed, however, with natural mucus, and in the progress streaked with blood. Sooner or later, uneasiness in the breast, inability to lay on one side, pain in the side, or under the sternum, and aggravated by inspiration and coughing.
The consuming hectic fever has generally two exacerbations during the twenty-four hours, about noon and night; with some degree of chilliness and shivering, and increased sensibility to cool air, notwithstanding the skin is preternaturally hot; the palms of the hands and soles of the feet burn; a florid redness, or circumscribed spot is perceivable in the cheeks; the other features are partial sweats about the neck and breast, particularly in the morning; disturbed sleep; slender, hoarse, and obscure voice; quick pulse; sometimes vomiting after meals; thirst; salt taste in the mouth; cough and expectoration, in frequency and quantity, varying in different persons; in some, there is a very considerable discharge of purulency from the lungs. Various ordeals have been proposed for the distinction of mucus from pus, or pulmonick ulceration. Mucus is naturally more transparent, viscid, and cohesive: pus always opake, more yellow and greenish; the odour more disagreeable, and the expectoration accompanied with a hectick fever. The sinking or swimming in water of the expectorated matter, is a precarious symptom, as it depends on the quantity of entangled air.
In this island, phthisis, especially from tubercles not suppurated, may continue one, two, or more years; appearing during the winter and spring, and disappearing during the summer. Other consumptions are much more rapid; in the vernacular phrase, galloping the patient to a skeleton in a few months. Phthisical patients are rarely confined to bed, until near the deplorable stages and fatal termination. Some have even a tolerable appetite; and the generality are cheered with adulatory hopes of recovery to the last extremity. The progressive encroachment is evident, by increased debility, emaciation, and partial sweats; edematous ancles; diarrhœa; depilation; consumption and melting away of the fat and muscular flesh: at last sapless, and macerated into ghosts, the twinkling vital snuff is extinguished. It is, as yet, impossible for me to apportion the comparative mortality and recovery in real confirmed phthisis; nor could I depend upon any of the general registers which I carefully consulted with this view. We may, however, venture upon a gross estimate, by negative proof. Exclusive of individual evidence, and medical attestation, we might, by a simple algebraic process out of any specified number, with their mortal diseases, and probable proportion of sick in each, sift out the consumptive. At all events, it cannot possibly be thought exaggeration to alledge, that not one out of seven consumptive recover. From hereditary entail, or tubercles, it is still more desperate.
are, hectick fever, atrophy and tabes; nervous; icterick; dorsal. Hectick fever and atrophy is described as a very frequent and fatal disease of infants, especially in cities; accompanied with emaciation, often short dry cough, hot skin and palms of the hands; quick pulse, thirst, diurnal exacerbations, sickly countenance: in some the abdomen is tense, tumid, and considerably enlarged. In simple atrophy the fever is not so acute; with tumid belly, irregular fecal discharge; voraciousness, indigestion, thirst, nocturnal sweats, unhealthy countenance. Atrophy and nervous tabes are confounded in medical diagnosticks: in both there is emaciation; but no considerable fever, cough, or difficulty of breathing; impaired appetite and digestion; leucophlegmatic sickly appearance, partial sweats; general debility, and proneness to faint on any exertion. Sometimes atrophy is circumscribed to a particular part or member. The icterick tabes is accompanied with symptoms of jaundice; and probably, under several disguises, is more frequent than medical authors have represented.
Dorsal, or spermatick, is a particular tabes; miserable spectacles of which are recorded by the celebrated Tissot. Its symptoms are, emaciation, yet good appetite; pain and weakness in the back and loins; disturbed sleep, and frequently interrupted by nocturnal dreams and pollution, either with or without pleasure; weakness of the knees and trembling of the muscles on the least exercise; sometimes a sensation as of thorns pricking the skin, and descending down the spine; pale sickly countenance, livid circle under the eye-lids; the feces and urine excreted with some difficulty, and often either with semen or prostate liquor. By degrees, the appetite decays with indigestion, hypochondriasm, melancholy; pains in various parts, headach, lumbago, universal debility, wasting of the penis, impotency and blight of future progeny. Females are not exempt from this disease; but it is much more frequent amongst the male sex, from the age of puberty through various adult stages of life: the foundation of it is often laid at schools; and in those seminaries of vice, large cities: and in some countries it is a more general habit of licentiousness than in others.
Of the predisposing and occasional causes of pulmonary hemorrhage, pulmonary phthisis, hectick, atrophy and tabes. Of pulmonary hemorrhage; hereditary; narrow thorax; weak pulmonary blood vessels, small capacity; plethora; suppressed natural or habitual hemorrhage, as nasal, hemorrhoidal, menstrual; amputation of a considerable extremity; luxurious living and indolence; violent exertion and exercise of the lungs and voice in various trades and professions; also violent efforts to cough, to exonerate the excretories; parturition; lifting great weights; violent exercise; furious passions of mind: external injuries on the thorax; wounds; confining the thorax by writing-desks, by strong whalebone stays; suppressed perspiration and exhalation of the skin and lungs by cold; light atmosphere, especially on high mountains; pulmonick inflammation; scrophulous lymphatick glands and tubercles in the lungs, or calculous concretions; polypus concretions in the large pulmonary blood-vessels; schirrus and obstruction in the abdominal viscera.
The predisposing and occasional causes of pulmonary phthisis are all the preceding causes of pulmonick hemorrhage; hereditary; scrophulous tubercles; suppuration in the lungs, and not with laudable pus; calculi in the lungs; consequence of pulmonick inflammation and suppuration, of small pox, measles, hooping cough, rickets; and of various acute and chronic diseases; venereal, icterick; chlorosis; worms; rheumatism; chronic asthma; internal abscesses and ulcers; catarrh and neglected colds; sudden suppression of perspiration, especially when the body is heated; pulmonary exhalation suppressed, and cold damp air inspired; irregularity and coldness of the climate joined to moisture; various noxious trades and occupations; noxious fumes and effluvia inspired; foul atmosphere of cities, coal fires; broken ribs and blows on the thorax; indigence; cold habitations; want of sufficient cloathing and fuel in rigorous seasons.
The predisposing and occasional causes of hectic, atrophy and tabes, are many of the causes just now enumerated: scrophulous obstructed mesenterick glands, and course of the chyle; colds; damp habitations; foul atmosphere of cities; moist cloudy atmosphere; unwholesome air; coagulated milk in the stomach and intestines; foul stomach; diseased stomach and abdominal viscera; improper diet; gluttony, sloth, uncleanliness, bad nursing, insufficient exercise; worms; repelled cutaneous eruptions and ulcers; cachexy; intoxication and intemperance; depressing passions of mind, cares, and vexations; intense study; insufficient nutriment, poverty, and want of food; frequent vomiting of food; faults in the organs of digestion; digestive fluids defective or depraved; profuse evacuations, as hemorrhages, diarrhœa, diabetes, fluor albus, salivation, seminal emission; delicate women suckling; sweats; rupture of the thoracick duct; diseases of the spinal brain; weakness of the solidum vivum; general defect of fluids, or of oil in the cellular texture; fever and absorption of the subcutaneous oil; old age and contraction of the small vessels; broken constitution, from various causes; frequent manustupration; libidinous books, prints; consequence of venereal gleets, and improper treatment.
In the London bills, Asthma and Tissick are forced into a connubial link: formerly it was consumption and tissick, the Italian name for consumption, and without any mention of asthma. It would appear by the London registers, that about one fortieth part of the memento mori’s in church-yards is from asthma; and its proportion to consumptive mortality as 1 to 8. I have every reason to believe that the funeral catalogue in London is not, in any outrageous degree, preternaturally overcharged with consumption or asthma. As both these diseases are properly excluded from in-patients of our hospitals, I applied to one of the largest dispensaries in London, the Aldersgate; in which there is necessarily an overflow of both these distempers; and with the intention of confronting and irradiating the bills of mortality. Almost every page of these books presented Asthma in no inconsiderable number; and above all, Phthisis, phthisis, phthisis, towering with gigantic bulk.
There is, unfortunately, in medical books such an exuberance of postulata, that I endeavoured to ascertain from facts and numbers, the sex and age in which asthma is most predominant; and also its absolute mortality. For this purpose I extracted and winnowed out of all the patients in the Aldersgate Dispensary during seventeen years, from 1770 to 1788, all the cases of asthma and dyspnœa: the result is as follows. Out of 70,000 patients, asthma and dyspnœa were 3,192; or one twenty-third of all the diseases; of which there were of males, 1613; females, 1536: dead, 169; relieved, 575: discharged, 569: cured all the remainder. The sundry ages of these were,—From birth to 10 years, 36; from 10 to 20, 25; from 20 to 30, 161; from 30 to 40, 429; from 40 to 50, 882; from 50 to 60, 949; from 60 to 70, 596; from 70 to 80, and upwards, 114.
From the preceding valuable records, and which, in this instance, happen to chime with the gross of medical observations, we may draw the following inferences: That in infancy and adolescence there are very few cases of asthma and dyspnœa: that these diseases chiefly occur in middle age and the decline of life: that more than one half of them are reported as cured; the relieved and discharged forming a neutral list, numbers of whom were either surfeited with medicines, or were discharged by their physicians when despairing of a radical cure, or fearful of their swelling the dead catalogue: in sinking of which there is a universal rivalship throughout our dispensaries and hospitals. Some of them, probably, were palliated, vamped, and amended; and indeed many were aged, for whom it would be unreasonable to expect a radical cure. I conceive, that with a part of them we may venture to double the dead list; which would raise asthmatick mortality to one of ten. But in the above estimate, what proportion legitimate periodic asthma bears to the other anhelations I could not fathom.
The term Asthma has been misapplied to every species of dyspnœa: it strictly denotes a chronic periodic difficulty of breathing, recurring and exasperated in paroxisms; and, at least in the intervals, without fever. Authors have subdivided it into several species; the spasmodic, convulsive, and periodical; the dry, humid, continued, flatulent: and from the gradations of difficulty in respiration, dyspnœa, orthopnœa. The periodick and spasmodick is the true disease. Generally, the day preceding the paroxism there is fulness of the stomach, impaired appetite, flatulence, eructation, tightness, and stricture about the breast, and difficulty of respiration; sometimes dry cough; the diaphragm descends with difficulty in inspiration: these are all increased by wine, fires, bed, and heat: the head is stupid, heavy, with slight pain, drowsiness, languor, yawning, restlessness of spirits; profuse excretion of colourless urine.
Asthmatic paroxisms commonly invade suddenly, or are greatly aggravated during the night, with constriction in the breast, anhelation and struggling in breathing, so that all the muscles of the thorax and shoulders are roused into action to enlarge the capacity of the lungs: this difficulty is greatest in inspiration: the patient is compelled to sit erect, or recumbent in bed, panting for breath, cool air, and drink; and can with extreme difficulty cough, expectorate, or speak: the respiration is slow, laborious, wheezing, and sonorous; with painful propensity to cough: from the interrupted circulation of blood through the lungs, the face and eyes are turgid and livid, in some the face is pale and bloated; with headach, somnolency; palpitation of the heart; weak and intermittent pulse; internal burning heat, and often cold extremities; eructation and flatulence, sometimes vomiting; difficult and sonorous deglutition; sweats; limpid urine; restlessness, or disturbed sleep. Some lay easier on one side than on the other. Many are under the necessity to sit erect in a chair during several days and nights, gasping for breath, not daring to repose in bed. Should both lobes of the lungs be equally constricted, the compound offices of this pneumatick and hydraulick organ will be obstructed, with more threatening symptoms of suffocation and strangling. A loaded stomach, close chambers, fires, beds, wine, noxious smells, all aggravate the paroxism.
In the duration, recurrence, intermission, and remission, asthmatic paroxisms vary. A few hours, or a few days, are the usual limits of this pulmonick tumult. In the beginning it continues only a few hours, with a diurnal remission and nocturnal renovation: in the chronic state, from two to five days is the usual duration. As the paroxism mitigates, there is flatulent explosion upwards and downwards, often with fecal discharge, and expectoration of mucus. The intermissions are proportioned to the duration of the paroxisms: the longer the paroxisms the longer the intervals, and vice versa: with a copious expectoration they sooner terminate, and are less severe. Some have had as many paroxisms in winter as in summer; and in the country as in town. Floyer had sixty in winter and twenty in summer: the latter, as usual, were more violent, and longer. During calm frosty weather asthmaticks are most secure; but at all points of the compass the paroxism may invade. Some find more ease in the city than country; others, in low ground than mountainous. Some are never entirely liberated from dyspnœa, and with periodical aggravations. Few, comparatively, die immediately in the asthmatic paroxism: numbers survive many years, even to the goal of longevity, and, emaciation excepted, without considerable diminution of strength, spirits, or appetite. After long continuance, it seldom admits of a radical cure; but only alleviation and respite. Its fatal terminations are suffocation, apoplexy; pulmonick inflammation; consumption, cachexy, partial or general dropsy; polypi in the heart and the large vessels.
The predisposing and occasional causes are hereditary; original structure of the pneumonick organs; narrow thorax; plethora; suppression of habitual or natural evacuations, and cutaneous eruptions, as menses, piles, old ulcers, sweat of the feet; consequence of catarrh and colds, and sudden suppression of perspiration: serum, pituita in excess; cachexy; dregs of fever, small pox, measles, and pulmonick inflammation; pulmonick tubercles; spasmodic stricture of the diaphragm and bronchiæ; smoky rooms and houses, especially with wood fires; noxious mineral and metallic fumes, arsenical, nitrous, sulphureous, saturnine; smoky atmosphere of cities; pulverulent trades, as stonecutters, lapidaries, millers, flax-dressers, chimney-sweepers; fetid offensive smells; sudden changes of weather and winds from heavy to a light atmosphere, portending storms, and especially snow; easterly winds; fogs, with unsteadiness of weather and seasons; possibly some secret alterations in the electrick fluid, and affecting electrometers; warm and moist air; errors and intemperance in food and drink, and ingurgitation; violent motion and agitation of body and of mind; symptomatick in various diseases, as hystericks, hypochondriasm, gout, pectoral dropsy, empyema, polypi in the heart or aorta; wounds of the lungs; diseases of the liver and spleen.
are symptoms of many diseases; and they are also primary, and very general maladies, especially in this island. It is true, we have here no compass to steer by: these are an exploded banditti; a sort of rebels to the symmetry of system, whose diagnosticks and therapeuticks are as yet slovenly and imperfectly noticed by medical authors. From the universal connection of the organs of respiration, their functions are more or less interrupted by and warped with other diseases and morbid symptoms. Many of the chronic impediments in breathing, and the broken-winded, may be called asthmatic excrescences, without its periodical paroxisms, exacerbations, and remissions; and without any rapid emaciation or hectick: they are spurious asthmas and chronic catarrhs. All the parts about the fauces and pharynx are crowded with mucous glands, from which, as in angina and catarrh, there is often a profuse secretion. Many persons advanced in life, and the aged, have a large discharge of mucus, variously, from the fauces, pharynx, larynx, lungs, stomach; all requiring frequent expectoration or hawking. The predisposing and occasional causes are many of those already enumerated under consumption and asthma. To these may be superadded cold pituitous temperament; air hot, cold, weighty, light, moist, impure, stagnant; changes and vicissitudes of the winds; cold moist climate and atmosphere, and especially in winter, autumn, and spring, and interchanges of the seasons; sudden vicissitudes, disorders and inconstancy of the surrounding elements; suppressed perspiration, and pulmonary exhalation; catarrhal defluxion on the lungs, larynx, fauces; mucus in excess, tenacious; faults in the mucus glands and ducts; trachea too sensible or irritable; calculi, chalky concretions, and inspissated mucus in the larynx; vascular or parenchymatous diseases of the lungs; original faults of the lungs, bronchiæ, larynx; wasted lungs; extravasated air; spasm of the respiratory muscles; flatulent farinaceous food, slimy food, and drink; weak or foul stomach, voraciousness; infants swallowing saliva; symptomatick in various diseases of the thorax, as consumption, asthma, empyema, polypus, aneurism, cum multis aliis: symptomatick in various diseases of the abdomen interrupting the play of the diaphragm; as full stomach, flatulence; pregnancy; dropsy; enlarged spleen or liver; tympany; nephritis; worms; injured abdominal muscles.